Bioidentical Hormones for Menopause. A Good Idea?

There’s a time during the menopause transition in which many women find their symptoms are overwhelming, especially if they have a lot of hot flashes or bad insomnia, which can make you feel pretty wretched.

At such times, it is very natural to want a quick fix, and the best that Western medicine can currently offer is bioidentical hormone replacement therapy which is marketed as a “healthy” alternative to conventional HRT. Bioidentical HRT is plant-based rather than synthetic or made from the urine of pregnant mares.

Here are some considerations to take into account while making your decision.

1) Women vary enormously in their ability to tolerate extra hormones that their body did not tailor make for them. If you had problems from being on the Pill, then HRT of any kind may cause too much disruption to be worth it.

2) Studies are remarkably inconclusive (probably because of (1) and also pharmaceutical industry bias. If you really dig into the research on bioidenticals, it’s pretty flimsy so far. While common sense might suggest that plant-based is better than synthetic or Premarin, there is little proof of this as yet.

3) My current best guess is that (very approximately) 50% of menopausal symptoms are the body’s way of adjusting to the ratcheting down of hormone levels and the changes in where hormones are made and how they function. (The other 50% is caused by other factors including lifestyle and the health of your endocrine system going into menopause, especially the adrenals.) So the symptoms themselves are part of an adjustment process and the body won’t adjust if you just shut the symptoms down. So taking any kind of hormone won’t help with that process of adjustment, it will merely mask it and possibly disrupt and delay it. I have heard many stories of women being on HRT for ten years and coming off it only to go right back to even worse hot flashes than they had in the first place, and being caught there until they get too old to even sweat much, presumably because they missed the window of adaptation. Are bioidentical hormones any different in this context? Certainly they are easier on the body re (1) but whether they set the body up for a worse or better old age we don’t know. Yet again, we are experimenting directly on a generation of women.

4) The reasons women give for *having* to take hormones are mostly either the demands of their job or their husband. Both of which can be altered (!) even slightly to alleviate symptoms along with making other changes. A study done in Australian workplaces in 2014 found that small changes such as desk fans and being able to open a window make a huge difference to women’s abilities to tolerate the workplace during the phase of peak menopause symptoms. Flexitime for a while can also be enormously helpful.

5) In cases of real and non-negotiable suffering unrelieved by lifestyle change (giving up alcohol, for example, can completely alleviate or certainly ameliorate hot flashes and night sweats) then minute doses of bioidenticals can be useful, for as short a time as possible.

It comes down to the individual situation. For me, four years on the Pill as a young woman in the ’70’s, when doses were much higher than now, made me super susceptible to hormonal medication — so there is no way I would have taken HRT. Even progesterone cream and soy, which I tried in the early stages of menopause when I had difficulty sleeping, were counter-productive.

Instead, consider the supportive regimes of Western herbal, Ayurvedic and traditional Chinese medicine. I did a year on Ayurvedic herbs about two years after I stopped menstruating when I was still suffering with insomnia and achey joints. It definitely helped. Traditional remedies for women (eg Dong Quai in Chinese med, Ashwagandha in Ayurveda) are primarily adaptogens and blood tonics. Rather than being pseudo-estrogens, their main purpose is to stimulate the body’s own mechanisms to produce homeostasis, reducing hormones if too much, stimulating production if too little. That can be very helpful when the body is in menopausal flux. Increasing the body’s ability to adapt is probably more beneficial than actually dumping hormones in.

And come to one of my Phoenix Rising workshops on healthy menopause to find out more about the physical realities of menopause and how to take really good care of yourself during this time, as well as how to process the psychological and spiritual aspects of the transition, which can also have an impact on physical wellbeing.

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8 Comments

Jenny Rose
on 24th July 2016 at 6:09 pm

Interesting that you write that the evidence on bio-identical hormones is ‘pretty flimsy’…
Dr John Lee spent his whole career researching and implementing the use of bio-identical progesterone for menopausal women, and this is very well documented in his best-selling books and videos.
I found that using progesterone cream greatly helped my symptoms of insomnia and hot flushes, as well as the turbulence and distress of being on an emotional rollercoaster, but only as a key ingredient in my ‘medicine bag’. I also stopped drinking alcohol, eating meat and drastically altered my diet to be far more alkaline, as well as cultivating a spiritual practice that embraced whatever presented itself to me as an opportunity for healing, release and growth.
At a time when it is easy to feel isolated, misunderstood, and at times quite desperate, I found that the daily use of progesterone cream helped to anchor me to a sense of self-empowerment and calmed the extremes of distress, whether physical or emotional.

Hi Jenny, I’m very glad to hear you have found progesterone cream to be helpful and that you’ve been so smart and taken all those other preventive and curative steps. Re Dr Lee’s work though, it has been widely criticised and his findings have yet to be successfully replicated. There is huge doubt now over his fundamental premise about the safety and efficacy of using progesterone alone. There is very little other evidence and still big question marks over safety and dosage. It is easy for women to accidentally overdose with creams and cause more problems. So again, as I say in the article, be careful and don’t assume that because something is touted as “natural” that this means it is safer or better.

Thanks for your post, Lara. I am keen to learn more about these bio identical hormones – my instinct tells me that I need to let my body go through its process as it chooses to. And that even though they are plant-based, they are still not of my body’s making. I had 3 or 4 night sweats and a month or two of mild hot flushes, but with less stress in my life I haven’t had any for ages. I had a herbal blend that includes St John’s Wort recommended by my naturopath (a colleague of Ruth Trickey). What do you think of herbal supplements? Would these plant based hormones act in a similar way to bioidentical hormones?
Would love to attend one of your Phoenix Rising workshops!

Hi Janoel! Yes, stress is a huge factor. Herbal supplements are not the same as BioIdenticals. In BioId’s the phytoestrogens and progestins have been extracted from plants, so they are much more concentrated. If you can find the right balance of herbs this is a good way to go. I’m just sorting out my schedule right now and plan to do at least one Phoenix Rising in Melbourne before the end of the year. Hope you will be able to come. Stay tuned!

Hi Sue, Yes but I am not sure of dates yet. I’m just planning my spring workshops. I haven’t taught in Sydney since 2012 so it’s time! If you sign up for my newsletter you’ll be sure to get a notification about it. Hope to see you there.

Hi Lara, thank you for this valuable advice. MY intuition is telling me not to use bio-identical hormones. I am in the UK and I heartily recommend Neal’s Yard Black Cohosh and Sage Menopause Mix (also contains other beneficial herbs, comes as a tincture.) plus, for me, dandelion tincture has helped with fluid retention and motherwort for, well, practically everything(!). But by far the most beneficial is to embrace this time as far as possible as an opportunity to truly work through any emotional and psychological “Stuff” we have been carrying through this first half a century or so of our lives. Menopause is not a big “mistake”…I am adding a “W” for “wonder” in there, like this “me-noW-pause…..

Hi Kate, That mixture from Neal’s Yard sounds great. And with herbs, one can experiment and see what is helpful without the level of risk of taking hormones. And yes absolutely, embracing the opportunity to release and then to rediscover oneself in a deeper and freer version is the great gift of menopause.